Leading from behind the curve

WASHINGTON – The nation of Liberia – founded by liberated American slaves with support from Henry Clay, Daniel Webster and James Monroe – is not unacquainted with suffering. Two civil wars in the period from 1989 to 2003 and decades of economic mismanagement caused an 80 percent decline in per capita GDP – perhaps worse than any country since World War II. Warlords reduced Liberia’s infrastructure to rubble. In the 15 years following 1991, there was no electricity in the country except for private generators.

When I last visited in 2012, President Ellen Johnson Sirleaf (Africa’s first female president) was leading a tentative recovery. She talked of action plans on reconstruction, development and health infrastructure. All are now in ruins. Sirleaf recently sent a letter to President Obama saying that Ebola threatens to “overwhelm us.” Her defense minister warns that Liberia’s “national existence” is at stake. Sirleaf just sacked 10 senior government officials who have fled the country and refused to return – hardly a reassuring development in a frightened nation.

So what difference does one more misfortune make in a distant, unfortunate place? A big difference, it turns out.

The welcome globalization of markets, culture and travel also involves the unavoidable globalization of threats, including terrorism and pandemic diseases. A virus infecting a single patient – perhaps, in this case, a 2-year-old boy from a Guinea border town who died just before Christmas in 2013 – can reduce three countries (Liberia, Guinea and Sierra Leone) to desperation and civil disorder, result in the August 2014 declaration of an international health emergency by the World Health Organization (WHO) and raise the prospect of further spread and (more remotely) of disastrous genetic mutation.

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There is no escape, no isolation, no sanctuary. Any doctrine of “non-intervention” in such a world is not only a dream but a danger.

This is the context in which President Obama has properly decided to step up the American response to the Ebola outbreak – a plan involving additional hospital beds, an expanding role for the Defense Department, and broader efforts to prevent the rapid spread of the disease in places such as Nigeria (which would be a regional and global nightmare).

Whatever the intentions of the president’s plan, its success will be measured by a few things. Speed is essential – even days of delay would have large consequences given the upward curve of cases. Coordination is key – other governments, international institutions and nongovernmental organizations need someone to be unequivocally in charge on the ground. And a massive education effort will be essential – the next stage of preventing transmission may require people who fear they are infected to stay in place, wait to see if they get sick, then be nursed by relatives with home-care kits (if an Ebola treatment facility is not readily available).

The Ebola outbreak is a continuing crisis that will doubtlessly demand further resources and effort. But it is also a stress test for future emergencies. The virus, at this point, spreads through contact with bodily fluids. Future threats may only require a touch or a cough. This is not alarmism, but a repeated pattern of struggle between humans and microbes, in which humans have often suffered massive casualties (the 1918 flu pandemic killed 3 percent to 5 percent of the world’s population).

This test has revealed several weaknesses:

First, we have seen how diseases take root and grow in parts of the world with fragile or nonexistent health systems, where the normal responses to disease outbreaks (case investigation, contact tracing) quickly break down. There is no better argument than Ebola for addressing massive global disparities in health infrastructure.

Second, we have seen the essential hollowness of the response of international institutions. The United Nations and WHO issue warnings and assemble road maps and blueprints, but they do not constitute an effective emergency response mechanism. The world needs one.

Third, we have seen that the United States government’s response to an outbreak can be fragmented and slow off the mark. The administration offered an incrementally growing response to an exponentially growing problem. In this case, expertise and a sense of urgency were scattered unevenly across bureaucracies including includes the Centers for Disease Control and Prevention, the National Institutes of Health, the Department of Health and Human Services, the State Department, the U.S. Agency for International Development and the Department of Defense.

All these varied capabilities – so essential during a global health emergency – become more difficult to summon from behind the curve.